DENTURE TEETH

Smriti Narayan Thakur,1st year,P.G resident, Department of Prosthodontics and Maxillofacial Prosthetics,PDCH 25-12-2011 1

Content
Defenition History Functions Desirable characteristcs Classification of Denture Teeth Conclusion References
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 DEFINITION PROSTHETIC TEETH are the artificial substitutes for the missing natural teeth usually made of porcelain or plastic.

 700 B.C.: tooth replacements included wood, bone, ivory teeth(carved by skilled artisans) and artificial teeth attached to natural dentitions with ligature or fixed to the metal plate held in the mouth

HISTORY

 15th century: 1st known European denture set included hinge device with upper and lower teeth set carved from a single material rather than individual unit.

 18th century: use of porcelain for denture construction

FUNCTIONS
The functions of prosthetic teeth are to: Restore the esthetic, phonetic and masticatory functions of the missing natural teeth. Transmit forces to the denture base through which they may be distributed by the prosthesis to all teeth and tissues contacted by rigid parts of the denture.

Maintain the integrity of the arch by supplying missing proximal contacts.

Maintain the position of opposing teeth by supplying missing incisal and occlusal contacts.

DESIRABLE CHARACTERISTICS
The desirable characteristics specific for prosthetic teeth are: Have the color(shade), translucency, size, shape, and characterization similar to the natural teeth they replace. Be easily shaped with conventional dental burs

Be easily characterized with conventional dental stains. Have a hardness and abrasion resistance similar to the opposing enamel or dental material. Chemically bond to the denture base material or RPD alloy to which they are attached. Be resistant to staining by oral fluids and Microorganisms.
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Be chemically inert. Be odorless and tasteless and not pick up odors or tastes from oral fluids. Have a surface which is dense to avoid harboring oral fluids and microorganisms. Be capable of being cleaned by customary oral hygiene technics and materials.
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Be of low initial cost and inexpensively repaired or replaced. Be capable of being repaired and replaced by customary dental technics and materials. Be strong enough to resist the forces which will be applied. Not soften or warp in hot water or conventional denture cleansing solutions.
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Classification of Prosthetic Teeth

Based on material Acrylic teeth Porcelain teeth

Based on the morphology of the teeth

Anatomic teeth Semi-anatomic teeth Non-anatomic teeth. Or 0o/Cuspless teeth Cross-bite teeth Metal insert teeth.

Inter-penetrating polymer network resin teeth (IPN resin) Gold occlusals Acrylic resin with amalgam stops

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Acrylic teeth
Acrylic resins, introduced in 1937 . simple processing technique Relative low cost of fabrication process.

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ACRYLIC TEETH
Plastic denture teeth/acrylic teeth have the following advantages : Natural appearance & sound. ease in adjustment Restoration of surface polish. Break & chip resistance. Last life of denture (5-7 years)
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Can be custom stained to match the color and characterization of the natural teeth.

Bond to most heat cured denture base resin 16

Acrylic denture teeth have the following disadvantages in comparison to porcelain denture teeth: Less wear resisstance-result in vertical dimension. Tendency to dull in appearance during use . Less esthetic

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 Tooth debonding, usually in the anterior region of the denture. Cause of detachment-

Major problem with acrylic teeth.

lesser ridge lap surface area available for bonding Direction of the stresses encountered during function
S. B. Patil, B. H. Naveen and N. P. Patil, Bonding acrylic teeth to acrylic resin denture bases: a review, Gerodontology 2006; 23; 131139 18

 Processes affect the achievement of a bond between the acrylic teeth and denture base resin: The polymerising denture base resin must come into physical contact with the denture tooth resin

The polymer network of denture base resin must react with the acrylic tooth polymer to form an interwoven polymer network (IPN)

S. B. Patil, B. H. Naveen and N. P. Patil, Bonding acrylic teeth to acrylic resin denture bases: a review, Gerodontology 2006; 23; 131139 19

Debonding may be the result of incompatible surface conditions at the tooth and base interface. The factors that contribute to this discrepancy are: Contamination of the joining surfaces. Difference in structure of the two components because of their different processing routes.

S. B. Patil, B. H. Naveen and N. P. Patil, Bonding acrylic teeth to acrylic resin denture 20 bases: a review, Gerodontology 2006; 23; 131139

Porcelain teeth
Porcelain denture teeth have the following advantages More esthetic. More dense surface which is hard, abrasive, resistant, less prone to stains and easier to clean. Greater wear resistance. Beter retention of surface polish & finishing. Not easily marreed or abraded during routine polishing procedure .

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Porcelain denture teeth have the following disadvantages

Difficulty in restoring surface polish after grinding. Do not bond to the denture base resin. Prone to chip or break if dropped on a hard surface. Can not be used in where available denture space is minimum. 22

Click in function. Accumulate stain around the gingival margin.

Abrade opposing natural teeth or teeth stored with resin or metal restorations. Must be mechanically attached to the denture base. The retentive pins and diatorics limit the amount of tooth modification which can be done. 23

COMPONENTS OF ARTIFICAL TEETH

PORCELAIN anterior teeth metal pins for mechanical retention in the denture base resin.

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 Porcelain posterior teeth retentive reccesses (diatorics) in the ridge lap-The fluid
denture base ma-terial flows into the diatoric hole and when hardened locks the teeth in place vent hloe in mesial & disatal aspect - Vent holes provide an escape for air as the denture base material flows into the diatoric hole.

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 COLLAR -Identifies area of tooth to be covered by denture base material. RIDGE LAP Area which normally overlaps alveolar ridge. PIN Gold alloy pin used to secure porcelain anterior teeth in the denture base.

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 DOT Identifies 1st and 2nd upper premolars and molars. 1 dot = 1st premolars and 1st molars, 2 dots = 2nd premolars and 2nd molars. Dots are always on mesial to facilitate identifying rights and lefts.. DASH Identifies 1st and 2nd lower premolars and molars. 1 dash = 1st premolars and 1st molars, 2 dashes = 2nd premolars and 2nd molars. Dashes are always on mesial to facilitate identifying rights and lefts.
Dot

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 FINISHING LINE A ledge used as a guide in trimming the wax on the denture base material.
Lingual Finish Line

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DIFFERENCE BETWEEN ACRYLIC & PORCELAIN TEETH

PROPERTY
Abrasion resistance Bonding Adjustability Staining Percolation

ACRYLIC
Low Chemical Easy Easyily Absent

PORCELAIN
High mechanical difficult Not stain Present

Clicking sound
Ease of fabrication Ease of rebasing Truma to denture bearing area Adjustability

Absent
Easy Difficult to remove acrylic teeth Less Easy

Present
Difficult Easy to remove acrylic teeth More difficult

Paul Mercie, Franois Bellavance, Effect of Artificial Tooth Material on Mandibular Residual Ridge Resorption, J Can Dent Assoc 2002; 68(6):346-50

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IPN RESIN TEETH

Inter pentrating polymer network resin
IPN - material developed by inorganic microfiller materials with an optimally matched particle size distribution are integrated into the polymer network.

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Properties
Outstanding abrasion strength Tissue friendly Resistant to plaque Colour stable Chipping-free grinding Outstanding impact strength Reduced absorption of water Exceptional polishing properties also after grinding in situ Good bonding with the denture base material

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Effects
Long life of the prosthesis High degree of biocompatibility Excellent wearing comfort Given the appropriate conditions, particularly suitable for implant restorations. Very quick acceptance of the dental restoration by patients
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Benefits
Reliable/safe manufacturing process of prostheses Patient satisfaction in all aspects Image building and maintenance for dental laboratory and practice
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Cosmo HXL
Material - 90 % HXL polymers (highly cross linked) 10 % INPEN polymers Shades - 14 V - Shades, w/o B1 & C1 Posterior cuspation - 23 - 25 Mould system - T - Tapered, 11 moulds R - Rounds, 4 moulds S - Square, 7 moulds
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 Forms - Anterior Upper (22 forms) Anterior Lower (7 forms) Posterior Upper (5 forms) Posterior Lower (5 forms) exceptionally high wear resistance stain resistance perfect color stability.
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Gold occlusal
considered to be best material to oppose natural tooth. very expensive require log fabrication time . so it is avoided.
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Indications
History of occlusal attrition Bruxism Orofacial tardive dyskinesia, Self-induced excessive chewing, Idiopathic parafunctional mandibular movement.
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 ADVANTAGES Improved wear ressistance. Bonding capibility eith denture base resin. Improve masticatory efficiency. Not as moisy as porcelain teeth. Strengthn the denture

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 DISADVANTAGES Cost metal insert teeth Not be as esthetic as other artificial teeth

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Technique
Remove the posterior teeth from the wax trial denture. After cleaning the denture teeth, position the teeth with the occlusal surfaces facing upward in the lower half of a denture flask filled with dental stone.

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 Coat the set stone with a separating medium. Flasking done . Trim away the gingival 23 of the denture teeth. Leave approximately 2 mm of denture tooth height as measured from the cusp tips to the undersurfaces of the cut surfaces.

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 cut away material from the underside of the teeth so that a uniform thickness of approximately 1.5 mm remains. Place multiple small undercuts in the denture teeth undersurfaces to serve as retention for the acrylic resin.

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 Attach sprue formers to the undersurfaces of the acrylic resin patterns.

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Investment done. casting After divesting the castings, recover the gold occlusal surfaces and polish.

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 Position the polished castings into their respective sites in the flask.

Select a heat-activated or chemical-activated resin that matches the shade of the anterior teeth.

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 After the acrylic resin has polymerized, deflask and separate the teeth.

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 Polish with an assortment of burs, pumice, and polishing compound.

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 Inspect the goldacrylic junction for any imperfections: voids, inclusions of debris, or discolorations.

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After the gold occlusal surface denture teeth have been fabricated, reposition them in the wax trial denture.

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 Due to the dimensional changes in the processing of the acrylic resin and minor alterations to the occlusal surfaces during the finishing and polishing. The tooth relationships may need to be altered to achieve the desired occlusal scheme.

wax try-in before final processing

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 The processed mandibular complete denture with gold occlusal surfaces

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Acrylic resing with amalgam stops

occlusal preparation made on the acrylic teeth.
Amlgam is condensed into the preparation occlusal correction is done in the articulator. Less expensive.

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Based on the morphology of the teeth

Anatomic tooth DEFENTIOIN-An anatomic tooth is one that is designed to simulate the natural tooth form. The standard anatomic tooth has inclines of approximately 33 degree or more. Teeth that have prominent cusps on the masticating surfaces and that are designed to articulate with the teeth of the opposing natural or prosthetic dentition Anatomic teeth with cuspal inclinations greater than 0 degrees that tend to replica natural tooth anatomyusage cusp teeth (30 to 45 degrees) are considered anatomic teeth. -GPT -8

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 More efficient in cutting & grinding food. Less masticatory effort & forces are needed. Balanced occlusion can be achived in eccentric jaw positions( protrusive, rt.& lt. lateral mvt.).

ADVANTAGES

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Cusp fossa relationship helps to guide the mandible into centric occlusion. Aesthetically & psychologically acceptable. Physical contours closely resemble natural teeth so more compatible to the oral cavity
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Disadvantages
Magnify the horizontal forces acting on the ridge. Teeth setting crusial to obtain proper occlusion.
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Cusp angles ranging between 0 degree to 30 degree. cusp angle usually around 20 degree.

Semi anatomic Teeth

Also called as modified anatomic teeth

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Development
In 1922 - victor sears designed 1st semi anatomic teeth. Also called as Channel tooth. Consisted of

Mesiodistal groove in all maxillary posterior teeth. Mesiodistal ridge in all mandibular posterior teeth Designed for unlimited protrusive movement & limited lateral movements

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In 1930- avery brothers modified channel tooth called as scissor teeth. Oppsite of the channel tooth . Grooves and ridges run buccolingually so that protrusive movement limited & lateral movement free. Designed to shear food in the lateral direction.

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Non anatomic Teeth

O degree or cuspless Teeth .

Defenition -The term nonanatomic as applied to

artificial posterior teeth, and especially their occlusal forms, means that such teeth are designed in accordance with mechanical principles rather than from the viewpoint of anatomic replication. --GPT-8 I. R. Hardy -first introduced nonanatomic teeth with flat occlusal surfaces set to a flat occlusal plane
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 Hall in 1929 designed 1st cuspless tooth- named as inverted cusp tooth. The occlusal surfaces flat with concentric conical depressions producing sharp conncenrtic ridge around central depression. In 1929 Myerson Truekusp Teeth. Teeth had buccolingual ridges on the ccclusal surfaces of both maxillary & mandibular teeth. The ridges of opposing teeth were parallel to each other.
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 In 1934 ,Nelson chopping block In this design -the maxillary teeth mesiodistal ridges & the mandibular teeth buccolingual ridges. Ridges occluded perpendicular to each other increasing the masticatory efficiency.

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 In 1939 swenson designed the Non- lock tooth. Occlusal surface flat with sluiceways.

Single buccal & lingual incline

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 In patient with bruxism decrease the force acting on the basal tissues.
Greter range of movements is possible.

Advantages

Use in patients with neuromuscular disorders where jaw relation can not be recorded.
Highly resorbed ridge.
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Disadvantages

Give unaesthetic appearance . Masticatory efficiency is less. Balanced occlusion can not be obtained. occlusion is in two dimensions where as mandibular movement is in three dimensions. Attempt to correct these teeth by occlusal grinding decrease their efficiency.
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Cross bite teeth

In 1927 Gysi designed cross bite teeth. Buccal cusp -maxillary teeth absent but large palatal cusp present which rest on the lower tooth. Used in jaw discrepancy cases leading to a posterior cross bite relationship.
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 1st designed by Hardy.

Metal insert teeth

Also called as vitallium occlusal. Each tooth look like the fusion of two premolars & one molar.

Vitallium ribbon is embedded in a zigzag pattern on 67 the occlusal surface.

The vitallium metal is slightly rasied above the occlusal surface.

on occlusion metal to metal contact produce greater cutting efficiency.

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Mold & shade identification

Artificial teeth are available in numerous mold & shades. Identifying codes are not standard through out the industry.

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Trubyte bioform mold numbering system

Left part of the tooth mounting card two numbers & one letter. 1st number- classification of mold 1- square 5. tapering ovoid 2. square tapering 6. ovoid 3. square ovoid 7. tapering ovoid 4. tapering
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 The second number indicates- the tooth is long,medium or short. 1. long ,straight 2. medium,straight 3. short,straight 4. long curved 5. medium, curved 6. short.curved.
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 The letter indicates width of all six anteriors teeth set on a curve.
B - less than 44mm. C - 44 to 46 mm D - 46 to 48mm E - 48 to 50 mm F or X - 50 to 52 mm G - 52 to 54mm H - 54 to 56 mm J & above 56mm 72

Conclusion
No one tooth is ideal for all types of ridges . Every artificial tooth has some advantages & disadvantages for both clinical & material poin of view. So select the artifical tooth according to patient clinical condition as well as his /her expectation.
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References
Patrick M. Lloyd , Laboratory Fabrication of Gold Occlusal Surfaces for Removable and Implant- Supported Prostheses J.Prosthodont 2003;12:8-12.
Sears VH. Thirty years of nonanatomic teeth. J PROSTHET DENT 1953; 3:596-617. THE GLOSSARY OF PROSTHODONTIC TERMS -8. Essential of complete prosthodontics 2nd edition sheldon winkler. Dental laboraory procedures complete denture . Vol-1 Rudd & Morrow. Harlod R.Ortman,complete denture occlusion ,Dental clinics of North America vol. 21,No.2,1977.

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 Paul Mercie, Franois Bellavance, Effect of Artificial Tooth Material on Mandibular Residual Ridge Resorption, J Can Dent Assoc 2002; 68(6):346-50. S. B. Patil, B. H. Naveen and N. P. Patil, Bonding acrylic teeth to acrylic resin denture bases: a review, Gerodontology 2006; 23; 131139

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